Considerable evidence is available in support of an independent association
between obstructive sleep apnoea syndrome (OSAS) and cardiovascular disease,
which is particularly strong for systemic arterial hypertension and growing for
ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac
sudden death. The pathogenesis of cardiovascular disease in OSAS is not
completely understood but likely to be multifactorial, involving a diverse range
of mechanisms including sympathetic nervous system overactivity, selective
activation of inflammatory molecular pathways, endothelial dysfunction, abnormal
coagulation and metabolic dysregulation, the latter particularly involving
insulin resistance and disordered lipid metabolism. The present report, which
arose out of a European Union Cooperation in the field of Scientific and
Technical Research (COST) action on OSAS (COST B26), reviews the current evidence
for an independent association and proposes research priorities to identify the
underlying mechanisms involved, with a view to identifying novel therapeutic
strategies. Large-scale collaborative studies of carefully defined patient
populations with obstructive sleep apnoea syndrome, adequately controlled for
potential confounders, are needed. Such studies carry the prospect of evaluating
potential interactions between different basic mechanisms operating in
obstructive sleep apnoea syndrome and cardiovascular disease, and interactions
with other related disorders, such as obesity, diabetes and dyslipidaemia.
Furthermore, translational studies involving cell culture and animal models
linked to studies of obstructive sleep apnoea syndrome patients are necessary to
integrate basic mechanisms with the clinical disorder.